Subdural empyema A review of 48 patients

The data of 48 patients with a subdural empyema, treated in the period 1946–1980, have been reviewed in order to evaluate factors that influenced the outcome. A delay in diagnosis and surgical treatment, plus a severe disturbance of consciousness at the moment of surgery, all had a negative bearing on the subsequent outcome. The mode of operation also had an influence on the outcome in this series. In those patients with a severely disturbed level of consciousness at the time of surgery, the outcome was more favourable if multiple burr-holes were performed rather than a craniotomy. In patients with a minor disturbance of consciousness, however, this difference was not apparent

The EEG in the diagnosis of subdural empyema

The EEG findings in 9 patients with a subdural empyema are reported. In all cases the EEG, recorded before the diagnosis had been established, contained focal zeta waves, extensive unilateral depression of cortical activity and, in all but one, a diffuse slowing of the background activity. This combination has not been reported before in the literature and it is concluded that in its presence the existence of a subdural empyema should be seriously considered. Comparison with CT scan findings in 3 cases indicated that sometimes EEG may be more sensitive than CT scanning in the diagnosis of subdural empyema. The value of EEG and CT scan in the diagnosis of patients with an acute or subacute bacterial meningo-encephalitis is briefly discussed

The EEG in the diagnosis of subdural empyema

The EEG findings in 9 patients with a subdural empyema are reported. In all cases the EEG, recorded before the diagnosis had been established, contained focal zeta waves, extensive unilateral depression of cortical activity and, in all but one, a diffuse slowing of the background activity. This combination has not been reported before in the literature and it is concluded that in its presence the existence of a subdural empyema should be seriously considered. Comparison with CT scan findings in 3 cases indicated that sometimes EEG may be more sensitive than CT scanning in the diagnosis of subdural empyema. The value of EEG and CT scan in the diagnosis of patients with an acute or subacute bacterial meningo-encephalitis is briefly discussed

The Nijmegen Modification of the Bethesda Assay for factor VIII:C inhibitors : improved specificity and reliability

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The significance of microemboli detection by means of transcranial Doppler ultrasonography monitoring in carotid endarterectomy

AbstractPurpose: Carotid endarterectomy (CEA) performed with continuous transcranial Doppler monitoring provides a unique opportunity to determine the number of cerebral microemboli and to relate their occurrence to the surgical technique. The purpose of this study was to assess in CEA the impact of cerebral microembolism on clinical outcome and brain architecture. We also evaluated the influence of the audible transcranial Doppler signal on the surgeon and his or her technique.Methods: In a prospective series of 301 patients, CEA was monitored with electroencephalography and transcranial Doppler ultrasonography of the ipsilateral middle cerebral artery. Preoperative and intraoperative risk factors were entered in a logistic regression analysis program to assess their correlation with cerebral outcome. To evaluate the impact of cerebral microembolism on brain architecture, we compared preoperative and postoperative computed tomography scans or magnetic resonance images of the brain in two subgroups of 58 and 40 patients, respectively.Results: Seven (2.3%) patients had intraoperative transient ischemic symptoms, three (1%) had intraoperative strokes, 1 (0.3%) had transient ischemic symptoms after operation, and 10 (3.3%) had postoperative strokes. Four (1.3%) patients died. Microemboli (>10) noticed during dissection were related to both intraoperative (p < 0.002) and postoperative (p < 0.02) cerebral complications. Microemboli that occurred during shunting were also related to intraoperative complications (p < 0.007). Microembolism never resulted in new morphologic changes on postoperative computed tomography scans. On the contrary, the phenomenon of more than 10 microemboli during dissection was significantly (p < 0.005) related to new hyperintense lesions on postoperative T2-weighted magnetic resonance images.Conclusions: During CEA the presence of microembolism (>10 microemboli) during dissection shows a statistically significant relationship with perioperative cerebral complications and with new ischemic lesions on magnetic resonance images of the brain. Moreover, microembolism during shunting is also related to intraoperative complications. Surgeons can be guided by the audio Doppler and emboli signals by changing their technique. This change may result in a decrease of microembolism and consequently in a decline of the intraoperative stroke rate. (J VASC SURG 1995;21:963-9.